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B.

Pathophysiology

a) Schematic Diagram (book – based)

Non – modifiable Risk Factors: Modifiable Risk Factors:


-45 y/o and above -Glucokinase mutation -Obesity -Sedentary lifestyle
-African American, Native -Familial history of DM type 2 -Stress -gestational DM
Americans, Asian American -Familial history of hypertension -Previously known Impaired - certain medication such as
Pacific Islander Fasting glucose Thiazides & corticosteroids.
-↑consumption of fatty, salty - Smoking
& sweet food - Alcoholism

Insulin resistance and desensitization

↓insulin production
↑glucagon Fats and Proteins
Release breaks down to glucose

↑blood Impaired glucose Cellular


absorption starvation Wasting
glucose
level
Weight loss /
Polyphagi
↑osmolalit fatigue
a
y
Chronic
Fluid shifts glucose Glycoprotein
from IC to IV
elevation cell wall
deposits
Sluggish blood
Cellular ↑blood volume flow Narrowing
of blood
vessel
Thirst ↑GFR
polyuri
polydipsia
Small Accelerated
vessel atherosclerosi ↑LDL
disease s

Hypertensio Coronary Artery


n
Diabetic Diabetic
retinopath neuropathy
Plaque rupture
y

Alteration numbnes
in vision/ s Exposure of subendohelial
blindness matrix
Foot
ulceratio
n Platelet activation

Diabetic
Change in Platelet ↑ Expression of
nephropathy platelet shape degranulation Platelet GP IIb/IIIa

Platelet adhesion Release of Thromboxane


ESRD to subendothelial A2, Serotonin and other Enhanced affinity
platelet aggregatory agent to fibrinogen
matrix

Platelet aggregation

↓ Arterial lumen Plasma Coagulation


System activation

Formation of
Enhances platelet
Converts aggregation
fibrinogen to
fibrin

Stabilization
Nidus of
of fibrin clot
rethrombosis
Backflow of
Impaired
blood in the Re-establishment of the
Productive
Adventitious Pulmonary repolarization of Blood Release
pooling on ↓ ventricular Irregular
lungs
the myocardium
endothelium
of with fibrotic
Hardening of Myocardial
cough
Breath sounds congestion lysosomal enzymes
left ventricle the function
coronary ↓cardiac contractility
↑BP, HR, and O heart beats
irritability
needs
Fatigue DOB
↓ oxygenation Lactic Angina
Anaerobic
ECG acid
changes
production
glycolysis Ischemia
↑ CKMB
Vasospasm
Impaired
ofMyocardial
the
Coronary
tissue ↓ perfusion
dislodges
cardiac
cell
supplied
occlusion
death
thrombus
by the arterySNS
vasocontriction
Stimulation2